Sexual|Reproductive Health

A Baseline Study and Social Norms Analysis using SNAP for the project BERHAN: Sexual and Reproductive Health and Rights Initiative in Amhara Region, Ethiopia

Background: BERHAN – Sexual and Reproductive Health and Rights initiative in Amhara region of Ethiopia seeks to support women and girls in Fogera and Estie woredas to safely exercise their sexual and reproductive health rights, leading to improved wellbeing (impact).

Objective: The purpose of this study was to understand the social norms that are associated with the practices of female genital cutting (FGC) and early marriage (EM), and to establish a baseline for all project indicators.

The quantitative survey was conducted on a randomly selected sample of 375 respondents comprising of men, women, girls, and boys (adults and adolescents). Quantitative data were collected using an interviewer administered structured questionnaire. Qualitative data were collected by masters and PhD degree holders, and quantitative data were collected by trained and experienced BSC level data collectors.

Results: The results revealed that FGC and EM were common practices in the community with a prevalence of 85.0% and 64.0% respectively. The community held the practices because of various reasons among which are cultural preservation and lack of knowledge. The community members were highly influenced by the sanctions that made them change their initial positions. Generally, women could not use contraceptive methods without permission from their partners or family members and this applies to all modern contraceptive methods.Only 3.7% of girls and women in the age group of 15-49 were able to use a modern contraceptive of their choice and, only 30.5% were able to decide on their own reproductive health care use. Read More...

Gender Gaps in COVID 19 Vaccines

COVID-19 vaccinations are quickly becoming a story of inequality. Gender inequality is a critical part of this story. In 16 countries where CARE has data, women are less likely to be vaccinated, and less likely to feel vaccines are safe.
There are massive local and global gaps in who can get vaccinated Only 1 9 of people in low income countries are vaccinated, and 79 of vaccinations have been in wealth countries Tragically, wealth and geography are just two factors that skew access to vaccines Another is gender In many low and middle income countries, women are less likely to get COVID-19 vaccines than men are This compounds gender inequality women are already facing in health and decision making Read More...

Regional project FAIR III “ For Active Inclusion & Rights of Roma Women in the Western Balkans III”

This intervention builds on extensive CARE’s expertise and experience in facilitating process related to women’s empowerment and gender equality across the globe and in the Balkan region. It also intends to scale up approaches and models that have proven successful over the last six years of the FAIR projects’ implementation (FAIR and FAIR II). The project seeks to empower Roma women and girls to be free and able to exercise their rights to live a healthy, dignified life free from violence, inequality and discrimination with support from their partners, families and communities in Bosnia and Herzegovina, Serbia and Montenegro. This will be accomplished through four output level results that need to be met for the longer-term changes to happen, they are inter-connected and mutually reinforcing since only in that way the outcome can be accomplished.

The first one (Output 1) refers to the enhanced capacities of Roma CSOs, youth and key community actors to practice and promote gender equitable, healthy and non-violent lifestyle with help of tested models and approaches. Under the second expected result (Output 2) Improved access to and provision of services for Roma, Egyptian (RE) women and girls (in particular on SRMH, GBV and Education) will be ensured through strengthening of the Roma CSOs and the existing participatory accountability community mechanisms. Output 3will enable three national-level Roma women networks to be active and contribute to the effective functioning of the regional Roma Women Balkans Network and its enhanced efforts towards Post 2020 EU Roma Integration Agenda. In the last expected result (Output 4), Roma women and girls, CSOs and Networks are part of the regional and global social movement initiatives promoting and advocating for gender equality and (minority) women’s rights. The project will directly target 26,150 people in total –aiming at 85% Roma and over 60% women and girls. Data collection under this project will be disaggregated by sex, age and ethnicity, whenever possible. Over20,000 people are expected to be reached in the three target countries through a series of promotional activities. Final Beneficiaries will include about 78,000 people in the 3 target countries based on the assumption that each target group person will reach out to at least 3 persons in his/her direct environment. [13 pages] Read More...

Endline Evaluation of Haushala Initiative of LEAD Program

Care Nepal has been implementing Haushala project which was designed to strengthen girls’ agency along with education outcomes, economic empowerment and adolescent sexual and reproductive health (ASRH) practices, hence helping to build sustainable change, including through creating a safer and more secure learning environment, facilitating social networks and gradually transforming traditional social norms with a negative impact on girls. The project also aimed to improve accountability and gender responsiveness of service providers for improved learning for girls.

During the evaluation both qualitative and quantitative data were collected using questionnaires, FGD and KII checklist for girls, parents, head teachers, cooperatives and school management committee. The data collection faced few limitations arising from COVID-19 which limited the logistical flexibility of the project along with created greater ethical consideration regarding health of the enumerators.

Girls reported that they perceived high parental support in their studies but this perception decreased with age. Parents and Girls both credit UALC and its program for aiding them and their children to attend formal schools. Parents were highly motivated by UALC and its stakeholders to help their daughter(s) to join formal education. However, it was also observed that the effort put by stakeholders such as schools and social mobilisers on influencing the parents who did not enroll their daughter(s) in formal school after UALC was not enough. But, as the transition was already very high and parents who did not send their daughter(s) for the first time were not that willing to re-enroll. Hence, the project can be deemed a success to certain point. [151 pages] Read More...

PROMOTION DE LA SANTE DE LA MERE ET DE L’ENFANT (PSME)

La vaccination et les services de planification familiale sont deux composantes importantes des soins de santé primaire. La plupart des femmes en période post-partum prolongée souhaitent retarder ou éviter d’autres grossesses mais beaucoup d’entre elles n’utilisent pas de méthode moderne de contraception. Une analyse des données provenant de plusieurs pays a montré que les besoins de contraception non satisfaits chez cette population étaient très importants, allant de 45 % à plus de 80 % des femmes en post-partum (Borda and Winfrey, 2008). La planification familiale permet aux couples d’avoir le nombre d’enfants qu’ils désirent et de choisir le moment et l’espacement des grossesses, ce qui permet d’améliorer la santé de la mère et de l’enfant. Les grossesses trop rapprochées peuvent représenter un danger pour la santé de la mère et de l’enfant (OMS, 2007a). Les grossesses espacées de moins de 18 à 24 mois ont été associées à des risques plus élevés de naissance prématurée, de faible poids de naissance, de décès fœtal, néonatal ou du nourrisson, et d’effets négatifs sur la santé maternelle (Conde-Agudelo et al. 2012). La vaccination des enfants est l’un des services de santé les plus équitables et les plus utilisés dans le monde. Le calendrier de vaccination et de soins de santé primaire recommandé pendant la première année de vie de l’enfant donne lieu à de nombreux contacts pour des soins de santé. Veiller à ce que des services et conseils de planification familiale soient liés aux contacts pour la vaccination des enfants via des services de santé primaire bien gérés peut permettre de proposer aux mères des informations et des services de planification familiale pendant la période critique des 12 mois suivant l’accouchement. Une modélisation à partir de données provenant de cinq pays d’Afrique subsaharienne a montré que le fait d’entrer en contact avec les femmes en post-partum au moment de la vaccination infantile pouvait faire diminuer les besoins de planification familiale non satisfaits de 3,8 à 8,9 points de pourcentage (Gavin et al. 2011). Dans ce contexte, CARE Benin/Togo, sur financement de la Fondation GSK en collaboration avec le Ministère de la Santé et de l’Hygiène Publique du Togo, a mis en œuvre depuis Décembre 2018 une initiative de renforcement du système de santé et d'intégration des services de vaccination et de planification familiale dans 11 Formations Sanitaires du district de la Binah dans la Région de la Kara au Togo, dénommée « Promotion de la Santé de la Mère et de l’Enfant (PSME) [48 Pages]. Read More...

COVID-19: Impacts, Attitudes, and Safety Nets in Haiti (April 2021)

In April 2021, CARE conducted interviews with savings group members and leaders to understand their experiences of COVID-19, and how it was changing their lives. The survey included 364 women and 175 men, for a total of 539 respondents. This follows a survey done in June 2020 to understand what was happening at that time for members of savings groups. The surveys covered Artibonite and Grand Anse.

COVID-19 continues to have important impacts for women and men in savings groups. In general, men and women in these groups were reporting similar challenges across the sample. 86% of women and men are reporting impacts in their livelihoods, and 98% of people say that COVID-19 is affecting their ability to save. 64% say they can’t meet family needs and hunger has gone up. 90% of people are reporting that COVID-19 is impacting their social lives. More women than men report that Gender Based Violence has gone up. While women are more likely to have lost influence in the household than men (39% compared to 33%), men are more likely to report that they lost social status in the community (48% compared to 43%). Read More...

COVID-19 Vaccination Uptake: A study of Knowledge, Attitudes and Practices of Marginalized Communities in Iraq

CARE Iraq conducted a study to better understand community acceptance of COVID-19 vaccination and existing barriers to vaccine uptake. The objectives of the study were to create an understanding of people’s knowledge, attitudes and perceptions about COVID-19 and the vaccines, establish what reasons undermine the COVID-19 vaccination campaign and inform about the status of vaccine uptake among marginalized communities. The results of the study can inform policy makers and health actors to design awareness campaigns and address barriers to vaccine uptake to increase the vaccination rate.

CARE found that:
• Vaccine hesitancy is high.
• Women have less access to, knowledge of, and willingness to accept the COVID-19 vaccine then men.
• Barriers to access are still high, and higher for women than for men.
• Fear of side effects is the biggest obstacle.
• There is little trust in the vaccination process.
• Many people do not believe vaccines are important.
• People are not confident they have enough accurate information.

Key recommendations
• Social media can be a primary channel for vaccine messaging.
• It’s critical to counteract misinformation.
• Multiple sources of information are critical.
• Focus messaging for women and religious leaders.
• Develop different messages in different areas.
• Build on people’s willingness to be convinced with good information. Read More...

Community Scorecard for COVID-19 Vaccines in Malawi

The significant amount of misinformation surrounding COVID-19 has deteriorated trust in governments and health systems, leading the World Health Organization to claim it as an “infodemic.” As the massive vaccine roll-out efforts launch, systematic trust-building and social accountability approaches are vital to ensure that civil society can hold governments accountable for equitable and people-centered vaccine roll-out that reaches the last mile. CARE knows that epidemics, like COVID-19 and Ebola, start and end with communities, which is why we are working to build meaningful citizen engagement into national vaccine roll-out frameworks to increase trust, accountability, and information dissemination.
CARE’s Community Score Card
The Community Score Card (CSC) was developed by CARE Malawi in 2002 and has been effectively used in a wide range of settings and sectors to ensure that public services are accountable to the people and communities they serve. CSC has demonstrated impact on power-shifting and improving service quality and trust building within and between communities and government actors. When COVID-19 arrived in Malawi during March 2020, CARE adapted CSC for remote use. The remote CSC includes an SMS platform and WhatsApp groups through which groups of men, women, youth, community and religious leaders, and service providers could voice their concerns and hesitancies about the vaccine and other health services. The CSC helped to identify major concerns around the vaccine and aided stakeholders in creating locally-driven solutions to combat vaccine hesitancy and misinformation.
Building on these early experiences, from May to June 2021, CARE further implemented a pilot project designed to support efficient and equitable COVID-19 vaccine roll-out in three locations in Malawi: Kandeu and Chigodi health facility catchment populations in Ntcheu district and the New Hope Clinic health facility catchment population in Ngolowindo in Salima district. In all three locations, key stakeholders included groups of women, men, youth, community leaders (chiefs and religious), district health management teams, and health personnel (including health surveillance staff, health facility staff in-charge, and the health center management committee). CARE Malawi’s CSC team led the implementation of the pilot with support from CARE USA and digital support from Kwantu. Read More...

Tabora Maternal & Newborn Health Initiative (TAMANI): Year 4 results

The Tabora Maternal and Newborn Health Initiative (TAMANI) is a five-year project led by CARE in partnership with the Government of Tanzania’s Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) and the Prime Minister’s Office for Regional and Local Government (PO-RALG). Implementing partners include the Society of Obstetricians and Gynecologists of Canada (SOGC), the Association of Gynecologists and Obstetricians of Tanzania (AGOTA), the Canadian Society for International Health (CSIH), McGill University’s Institute for Health & Social Policy, and Ifakara Health Institute (IHI). The project is financially supported by the Government of Canada and is closely aligned to Government of Tanzania (GoT) health polices, strategies and guidelines.
The Annual Report covers the period of April 1, 2020, to March 31, 2021.The report provides an analysis on operations to date against the Year Four Annual Work Plan. This report also highlights how the project
pivoted to respond to the COVID-19 global pandemic and includes reporting on COVID response programming as approved by GAC in March 2020. Read More...

COVID-19 Response in Tabora Tanzania (Bloomberg)

CARE Tanzania builds on its successful partnership with the Government of Tanzania’s Regional Health Management Team (RHMT) in Tabora Region. Leveraging funding from the Government of Canada as part of the Tabora
Maternal Newborn Health Initiative (TAMANI), CARE’s Bloomberg-funded COVID-19 activities builds on efforts to improve access of and quality of health services across health facilities and communities to challenge harmful gender norms.
In partnership with the Government of Tanzania, activities cover all 8 districts in Tabora Region. CARE provides technical support and training to Community Health Workers, who are supported by the government in their duties.With the onset of COVID-19, CARE Tanzania quickly implemented a digital survey to understand the impacts of COVID-19. The majority of female respondents reported increases in gender-based violence and harassment, with COVID-19 restricting women’s access to resources and decision-making. Read More...

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